Breast Reduction 2 – Which Technique is Best for You

Mr Richards describes different Breast Reduction or Mammoplasty techniques such as superior, inferior, lateral pedicle to help you decide which one is best for you depending on which type of scarring each technique produces. For more information or should you wish to book a FREE Consultation with our specialist plastic surgeon, please call us on 01844 214362.

Breast Reduction 2

Which Technique Is Best For You

Hello. I’m Adrian Richards. I’m a plastic surgeon and the Surgical Director of Aurora Clinics based here in the United Kingdom. This is the second part of videos we’re producing on breast reduction surgery. In this video, I’m going to be talking about the different techniques that can be used.

Essentially, breast reduction when it was first done was performed by a lot of varying techniques. One of the ones that used to be used is a technique called a free nipple graft. This is basically where the nipple was removed. They actually shaved off and removed – you could have walked out of the room with it – and then it was placed back as a skin graft where the blood flow re-establishes to the nipple. That’s not a technique we use anymore because it produces poor scarring, and the nipple doesn’t have sensation and you won’t be able to breast feed. So that’s really a technique that’s not used anymore. So free nipple grafting I think we can discount.

What we tend to do now is preserve the blood supply to the nipple on a bridge of tissue. We need to preserve the connections of the nipple to the breast. So we remove the tissue around this, so the nipple is kept attached by a bridge of tissue which plastic surgeons call a pedicle. The tissue around the pedicle is removed, normally from the lower part of the breast. We always have it analysed just in case there are any abnormalities in it. The pedicle, which carries the nerve and blood supply to the nipple, can either come from the top, the side, the outer side, inner side or below. A pedicle from the top is called a superior pedicle, from the bottom inferior pedicle, from the inner aspect a medial pedicle, and from the lateral aspect a lateral pedicle. So when you hear people talking about which pedicle they’re going to use, it’s just basically where the bridge of tissue that supplies the nerve supply and the blood supply to the nipple is based. Okay? So I hope that’s clarified that issue.

The next issue is the scarring that’s going to be involved. Now with a breast reduction, the nipple is lifted to a higher position, so there will always be a lollipop scar at the very minimum, which is a scar around the nipple where the nipple has been lifted up to and a vertical scar down to the fold beneath the breast.

In small breast reductions, there’s a technique which has been popularised by Madeleine Lejour in France and Elizabeth Hall-Findlay in Canada, which is called a vertical scar reduction. The scar is only the lollipop scar around the nipple and down. This is really only suitable for small reductions in probably younger patients. For bigger reductions in slightly older patients, we need to add a transverse element to the scar, and that makes it into an anchor. So the anchor is the lollipop scar, the round scar and then down with the cross bit as well, so that makes it into an anchor. Depending on how much tissue there is and how big the reduction is going to be, that varies the size of the transverse scar. So you really need to discuss with your surgeon, number one, are you a candidate for a vertical scar reduction? Number two, do they favour an anchor pattern reduction? That’s also known as a Wise pattern reduction. W-I-S-E after the gentleman who invented the anchor or first described the anchor pattern reduction. So you need to ask, what’s the plan? Is it going to be a vertical scar, a lollipop scar, a short transverse scar with a short scar underneath, or a full anchor Wise pattern reduction?

I advise you to ask those questions. If you want to appear knowledgeable, ask them what pedicle they’re going to use and what pattern of skin incision they’re going to use.

I hope you found that useful. Please feel free to watch the rest of the videos in this series, which are going to discuss how you prepare for the operation, the operation recovery period, things that can go wrong. Thank you.